"The whole PUM concept is a joke. It has not worked out anywhere it has been implemented. The dickwads that sell it (Fitch and Associates and some other idiot) make all sorts of promises about how it will save the area huge money and will pay for itself within so many years. It never has. It never will. They always end up spending more money than they ever have had to before. Subsidies go up, not down. Response times go up, not down. None of the promises are ever fulfilled. "
Dustdevil,
Please excuse me for I am sure I do not have the backing of your experience, and I definately don't proclaim to be an expert... but in persuit of an academic debate:
Where is the proof that the PUM concept is a joke? SSM and Dynamic deployment, response time reliability, a dedicated medical control board, oversight by an authority - if practiced correctly, these will make for an excellent EMS system for the PATIENT. Obviously in terms of the provider, the PUM system sucks balls... but then again, do we forget that we are here for other reasons than to play with loud boxes that have flashy red lights on them?
In my examination of the Tulsa, KCMO, Pinellas County systems, these all appear to be well run systems with the PATIENT in the forefront of the decisisons. Paramedics plus has replaced AMR in several cases with great success. Providers are somewhat happy, they get great experience, and they get out and go to the fire department, or a cushy third service (godwilling). Yes, you sit in an ambulance for 12 hours, your unit is probably run ragged, benefits are crap, pay is crap, you eventually hate your job, and like I said want to get out. But the system in theory works; for cheaper than what you would pay for a huge fire department based system
Lets take Baltimore City for example. Population close to a million, high density, hospitals close together, two 8 hour day shifts, two 14 hour night shifts. All 22 medics are on 24 hours a day. Taking computer records, and my memory may be a little hazy, The biggest call volume of the day is at 3:00 in the afternoon and the evening hours of friday, saturday, and sunday. The computers can show you this. There are NEVER 22 calls at 3:00 in the morning. In fact the most at that time of night might have been maybe 7 going at any one time. Yet the city is still paying 44 providers (sometimes 2 medics per ambulance, sometimes 1), 24 hours a day, 365 days a year. This is a tremendous disallocation of resources. In addition, ambulances are pretty much randomly dispatched wherever they are needed. When I was riding, in the city, a 20 minute response time was NOTHING. And this is because they didn't know where the units where. Oh, and medical accountibility, hah! There are great paramedics, but there are some downright AWFUL providers in there as well.
However, lets say you had 22 ambulances on dynamic deployment shifts, with SSM, and geolocation. Same pay, same benefts. However, now you added non emergency transports, and interfacility transports to the mix. Well, now you make more money because the non emergency transports actually pay - as opposed to those citydwellers that we all love. You can actually operate off of less a budget than before because the non emergency transports subsidize your emergency transports. Or keep the same budget, and you can now afford new ambulances, or god for bid, other benefits for your providers.
PUMS will only work though if certain conditions are met, including a dense population, about 1 million people, the monopoly of a provider, and if old data has been kept.
As I said, the providers hate PUMS, because they stay busy as all hell. However, the patient and the taxpayer benefit in the end.
What do ya think?
BTW, from what I can tell, AMR does suck at PUMS
Sam